The Use of Visual Rating Scales to Quantify Brain MRI Lesions in Patients with HIV Infection.

TitleThe Use of Visual Rating Scales to Quantify Brain MRI Lesions in Patients with HIV Infection.
Publication TypeJournal Article
Year of Publication2018
AuthorsRobinson-Papp, J, Navis, A, Dhamoon, MS, Clark, US, Gutierrez-Contreras, J, Morgello, S
JournalJ Neuroimaging
Date Published2018 03
KeywordsAdult, Brain, Female, HIV Infections, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Neuropsychological Tests, Reproducibility of Results, White Matter

BACKGROUND AND PURPOSE: Human immunodeficiency virus (HIV)-infected patients commonly have abnormalities in cerebral white matter that are visible on magnetic resonance imaging (MRI) as hyperintensities (WMHs). Visual rating scales (VRSs) have been used to quantify WMH in other diseases such as cerebral small vessel disease (CSVD), but not in HIV. Such scales are advantageous because they are applicable to routinely acquired MRIs and so are suitable for large-scale studies and clinical care. We sought to establish the utility of three VRSs (the Fazekas, Scheltens, and van Sweiten scales) in HIV.METHODS: The Manhattan HIV Brain Bank (MHBB) is a longitudinal cohort study that performs serial neurologic examinations and neuropsychological testing. All brain MRIs (n = 73) performed for clinical purposes on MHBB participants were scored using the three VRSs. We assessed reliability, validity, and correlation of the VRS with clinical factors relevant to HIV and CSVD.RESULTS: The VRSs all showed acceptable internal consistency and interrater reliability and were highly correlated with one another (r = 0.836-0.916, P < .001). The Fazekas and Scheltens scales demonstrated more WMH in periventricular regions, and the Scheltens scale also suggested a frontal to occipital gradient, with greater WMH frontally. All three VRSs correlated significantly with cognitive impairment (global T score). Age and hepatitis C virus antibody serostatus were the strongest clinical/demographic correlates of WMH, followed by African-American race.CONCLUSIONS: VRSs reliably quantify WMH in HIV-infected individuals and correlate with cognitive impairment. Future studies may find routinely acquired brain MRI quantified by VRS to be an accessible and meaningful neurologic outcome measure in HIV.

Alternate JournalJ Neuroimaging
PubMed ID28833868
PubMed Central IDPMC5821603
Grant ListK23 MH096628 / MH / NIMH NIH HHS / United States
R24 MH059724 / MH / NIMH NIH HHS / United States
U24 MH100931 / MH / NIMH NIH HHS / United States